Voiding dysfunction in women following cesarean delivery

Protracted Postpartum Urinary Retention: Incidence, Risk Factors, and Natural History of a Rare Postpartum Urinary Retention Subtype

IMPORTANCE

Postpartum urinary retention (PUR) is a multifactorial condition that requires a high degree of clinical suspicion for timely diagnosis and proper intervention.

OBJECTIVES

The aims of the study are to describe PUR incidence and to compare natural history, obstetric characteristics, and associated risk factors for protracted PUR (extending ≥3 days postpartum) versus PUR.

STUDY DESIGN

This is a retrospective cross-sectional study of women who underwent an obstetric delivery over 24 months at an academic institution. International Classification of Diseases, Tenth Revision, codes were used to identify PUR. Patient characteristics, obstetric delivery data, and peripartum care surrounding delivery were collected. A P value of 0.05 or less was significant.

RESULTS

Between January 1, 2018, and December 31, 2019, there were 23,844 deliveries (vaginal and cesarean section) and 77 patients (0.32%) experienced PUR. Within this group, 12 (0.05%) experienced protracted PUR. Patients with protracted PUR had a significantly later postpartum diagnosis day (median 1 [interquartile range, 1-2] vs 1 [0-1], P = 0.004), longer time to retention onset (22.0 [10.7-37.0] vs 10.7 [7.9-19.4] hours, P = 0.03), and greater retention duration (12.5 [5.5-17.0] vs 1.0 [0.0-1.0] days, P < 0.001) compared with those with PUR. There were no significant differences in patient or delivery characteristics for those delivering vaginally between the groups.

CONCLUSIONS

Protracted PUR is rare, occurring in 0.05% of deliveries. Women with protracted PUR were more likely to have a greater onset time, later diagnosis date, and longer retention duration, out to 47 days, compared with women with PUR resolution before postpartum day 3.

Postpartum voiding dysfunction following vaginal versus caesarean delivery

In this prospective study, we evaluated postpartum voiding dysfunction stratified by mode of delivery - vaginal delivery versus elective caesarean delivery (CD). We recruited nulliparous women carrying singleton gestation at term admitted to delivery room or elective CD. Pre-labour voiding function was assessed by recording the post-voiding residual volume (PVRV) using a bladder scan. PVRV evaluation was repeated at least 12 hours following delivery and before discharge. PVRVs were considered abnormal if ≥150 mL. PVRVs were compared between vaginal and CD. Overall, 54 women were included. Of them, 34 (63%) delivered vaginally and 20 (37%) had an elective CD. Postpartum mean PVRVs were significantly higher compared to pre-labour PVRVs (215 vs. 133 mL, p<.001). Abnormal postpartum PVRV was significantly higher in vaginal delivery compared to CD (73.5% vs. 45%, p<.05). In conclusion, delivery adversely affects voiding function. Vaginal delivery is associated with more severe voiding dysfunction compared to elective CD.Impact StatementWhat is already known on this subject? Delivery is associated with voiding dysfunction. While most studies on postpartum voiding dysfunction were related to vaginal delivery, little is known on the effect of mode of delivery (vaginal versus caesarean delivery (CD)) on voiding dysfunction.What the results of this study add? In this study, we found that postpartum post-voiding residual volume is significantly higher than the pre-labour PVRV in women delivered vaginally. In addition, postpartum PVRV was significantly higher in women delivered vaginally compared to elective CD.What the implications are of these findings for clinical practice and/or further research? This study implicates that women with vaginal delivery are more prone to voiding dysfunction compared to elective CD. However, larger observational studies are warranted to confirm these results and evaluate whether this difference still exists beyond the post-partum period.

Acute kidney injury in pregnancy

PURPOSE OF REVIEW

Pregnancy-related acute kidney injury (Pr-AKI) is associated with increased maternal and fetal morbidity and mortality and remains a large public health problem.

RECENT FINDINGS

Pr-AKI incidence has globally decreased over time for the most part. However, the cause presents a disparity between developing and developed countries, reflecting differences in socioeconomic factors and healthcare infrastructure - with the noteworthy outlier of increased incidence in the United States and Canada. Although Pr-AKI can be secondary to conditions affecting the general population, in most cases it is pregnancy specific. Septic abortion, hyperemesis gravidarum, and hemorrhage have become less prevalent with access to healthcare but are being displaced by thrombotic microangiopathies, such as preeclampsia, hemolysis, elevated liver enzymes, low platelets syndrome, thrombotic thrombocytopenic purpura, and pregnancy-associated hemolytic-uremic syndromes, as well as acute fatty liver of pregnancy. Understanding these conditions plays a pivotal role in the timely diagnosis and enhancement of therapeutic approaches.

SUMMARY

In this review, we focus on the renal physiology of the pregnancy, epidemiology, and specific conditions known to cause Pr-AKI, summarizing diagnostic definition, insights in pathophysiology, clinical considerations, and novel treatment approaches, thus providing the reader a framework of clinically relevant information for interdisciplinary management.